Two new "fixed stars" are giving periodontology a clear direction: the valid S3 guideline and the COVID-19 triggered insight into the close connection between oral health and general health. Both impulses generally bring about opportunities for the dental practice, especially for the periodontal team and in a wider sense also for the dental laboratory. The 40th International Dental Show (IDS) shows the possibilities and offers the opportunity for a professional exchange like no other industry event - coming up soon in Cologne from 14 to 18 March 2023.
The S3 guideline of the European Federation of Periodontology (EFP) has been implemented in Germany for peridontal therapy since mid-2021. This has caused a row of positive impulses. In this way, the "periodontal explanation and therapy discussion" (ETD) and the "patient-specific oral hygiene instruction" (OHI) can be invoiced according to the nationwide fee schedule (BEMA). This underlines the significance of consistent periodontal therapy and prophylaxis. Its main goal is to involve the patient in all four therapy stages. This is why domestic oral care, where applicable smoking cessation and optimal diabetic control already play important roles. For example, periodontitis encourages a row of diabetes-related secondary diseases and can increase the mortality rate.
This shows the close connection between oral health and general health. Furthermore, periodontitis is linked to rheumatism, heart attacks, strokes and chronical respiratory diseases. This has only become evident to a high number of patients as a result of the findings of the COVID pandemic. A broad cross-section of the public knows: Thorough periodontal therapy and prophylaxis can help prevent a severe case of COVID-19. Because COVID-19 patients with periodontitis are at higher risk of having a more severe case of the disease. Hence, the patient may possibly have to be admitted to intensive care or require artificial respiration.
Patients take note of such strong restrictions to the quality of life and can be won over for consistent prevention and therapy. The periodontal team encounters a strong readiness to carry out precautionary measures because the periodontal therapy and prophylaxis is considered to be essential due to the COVID-19 catalyst. And thanks to the far-reaching state-paid services pursuant to the new S3 guideline, the necessary measures can normally be invoiced much more simply than before and are thus easier to calculate economically.
The trusted aids are available for domestic oral care: Toothbrushes, toothpaste, dental floss, etc. Mouthwashes also prove to be effective in reducing the risk of a COVID infection which - according to surveys carried out at the Claude Bernhard Lyon University - already reduce the viral load in the mouth by 71% after just one single rinsing and which support the immune system in fighting an infection.
Especially in the case of periimplantitis, it is recommended to use antibacterial and anti-inflammatory toothpaste on an interdental brush in addition to the customary cleaning routines. In this way, the active ingredients reach the boundary surfaces between the implant and the tissue while brushing one's teeth. The background of this strategy is that unlike a natural tooth, the implant receives no special protection through the gingival crevicular fluid.
Manual tools and ultrasonics are used for the professional removal of plaque.
As is the case for domestic oral care, periimplantitis is also gaining in significance in the dental practice. In contrast to periodontitis, special features have to be heeded. For example, special non-vibrational ultrasonic systems that purely work with vertical oscillations can be implemented for the removal of tartar and calculus. An airflow device may need an application to clean pockets that are much deeper than just two millimetres subgingival. A swab soaked in CHX can be used as an antiseptic measure. A tight connective tissue collar can then be applied for example with the help of a very strong alkaline pH value. Subsequently the activity of the osteoclasts are reversibly inactivated using a collagenase inhibitor to prevent bone from growing and/or to balance out the bone remodelling.
In the case of well-advanced periodontitis, soft tissue surgery may be necessary in line with the S3 guideline in therapy stage 3. For the subsequent tissue regeneration, autologous blood concentrates such as PRF (platelet-rich fibrin) could play a more significant role in future. They are obtained from the centrifugation of patient blood from the peripheral blood vessels.
"The differentiated approaches show how individually the therapy and prophylaxis of periodontitis and periimplantitis are contemplated and carried out," summed up Mark Stephen Pace, Chairman of the Association of German Dental Manufacturers (VDDI). "Since the respective measures have an impact on much more than the mouth, going to the dentists is an essential element in a comprehensive prevention strategy. As the leading trade fair of the dental industry, IDS 2023 offers the ideal opportunity to inform oneself about current concepts and tools for successful and efficient dental care and to engage in an exchange with professionals."
IDS takes place in Cologne every two years. It's taking place for the fortieth time in 2023 and was founded 100 years ago. For info, see www.ids-cologne.de.